RICHARD D WATKINS CANTON COMMUNITY CLINIC INC. (NPI# 1427132984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427132984 |
| Entity Type | Organization |
| Organization Name | RICHARD D WATKINS CANTON COMMUNITY CLINIC INC. |
| Other Organization Name | CANTON COMMUNITY CLINIC |
| Practice Address |
2725 Lincoln St E Canton OH 44707-2769 |
| Practice Telephone | 3304542000 |
| Practice Fax Number | 3304546184 |
| Mailing Telephone | 3304542000 |
| Mailing Fax Number | 3304546184 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-02-01 |
| Authorized Official Name | PENNY A GEMBAROSKY (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 3304542000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0119875 | 05 | |
| MEDICARE PTAN | 3619131 | 01 |
| Other Name | Type Code |
|---|---|
| Canton Community Clinic | Doing Business As Name - Organization |
| Street Address |
2725 LINCOLN ST E |
| City | CANTON |
| State | OH |
| Zip Code | 44707-2769 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326007501 | Irwin Lilenfield | Family Medicine | 2725 Lincoln St E, Canton, OH 44707-2769 | 2006-03-17 |
| 1942765953 | Jodi Lynn Johnson | Nurse Practitioner | 2725 Lincoln St E, Canton, OH 44707 | 2019-02-04 |
| 1003305855 | Shakeilah Carelle Burns | Nurse Practitioner | 2725 Lincoln St E, Canton, OH 44707-2769 | 2018-05-08 |
| 1114373016 | Emily Reusser | Dentist | 2725 Lincoln St E, Canton, OH 44707-2769 | 2016-05-10 |
| 1073986873 | Kasey Mercurio | Nurse Practitioner | 2725 Lincoln St E, Canton, OH 44707-2769 | 2015-11-03 |
| 1720410194 | Michelle A Nesbitt | Dental Hygienist | 2725 Lincoln St E, Canton, OH 44707-2769 | 2013-08-07 |
| 1093073546 | Rachel Lester | Registered Nurse | 2725 Lincoln St E, Canton, OH 44707 | 2012-05-02 |
| 1932433240 | Michelle D. Husted | Counselor | 2725 Lincoln St E, Canton, OH 44707-2769 | 2009-09-21 |
| 1407012206 | Rebecca J Richards | Social Worker | 2725 Lincoln St E, Canton, OH 44707-2769 | 2008-07-31 |
| 1528227105 | Richard D Watkins Canton Community Clinic Inc | Clinic/Center | 2725 Lincoln St E, Canton, OH 44707-2769 | 2008-06-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649781717 | Linda Wilt | Licensed Practical Nurse | 620market Ave. S., Canton, OH 44707 | 2017-10-17 |
| 1558872622 | Michele Rose Strongoli-scott | Registered Nurse | 1620 Market Ave S., Canton, OH 44707 | 2017-10-17 |
| 1366972234 | Terri Sue Clendenin | Home Health Aide | 1317 Mattie St Sw, Canton, OH 44707 | 2017-06-14 |
| 1215467311 | Draya K Ellis | Community Health Worker | 408 9th Street Sw, Canton, OH 44707 | 2017-06-13 |
| 1720537780 | Individual | Preferred Provider Organization | 1111 Gonder Avenue Se, Canton, OH 44707 | 2016-09-30 |
| 1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
| 1184070526 | Mj Harvey Development, LLC | Day Training, Developmentally Disabled Services | 804 Marion Ave Sw, Canton, OH 44707 | 2016-05-04 |
| 1164898516 | Erica Marie Brown | Occupational Therapy Assistant | 1620 Market Ave., South, Canton, OH 44707 | 2015-08-19 |
| 1508256439 | Kenny Mcclelland | Military/U.S. Coast Guard Transport | 903 Alan Page Dr Se # Apt1, Canton, OH 44707 | 2015-01-30 |
| 1295143550 | Susan Elaine Ball | Technician | 908 6th St Sw, Canton, OH 44707 | 2014-07-30 |
| Find all providers in zip 44707 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
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| 1326435199 | Forever Kids Pediatric Clinic | Clinic/Center | 182 Privatet Road 6413, Canton, TX 75103 | 2015-04-20 |
| 1265834949 | Kcc Health Promotion Services LLC | Clinic/Center | 1821 Maple Park Dr W, Canton, MI 48188-4829 | 2014-09-24 |
| 1033435680 | Psp Medical Clinic, LLC | Clinic/Center | 1171 Hart St., Canton, MS 39046 | 2010-04-07 |
| 1982933487 | Atlas Healthcare and Rehab Holly Springs | Clinic/Center | 2945 Holly Springs Pkwy, Canton, GA 30115-7449 | 2009-12-11 |
| 1902088453 | Canton Family Clinic Inc. | Clinic/Center | 120 E Academy St, Canton, MS 39046-4502 | 2007-11-27 |
| 1255413639 | Vibha Vig Md Pa | Clinic/Center | 156 River Oaks Dr, Suite A, Canton, MS 39046-5376 | 2006-10-19 |
| 1235671926 | Canton South Family Healthcare, LLC | Clinic/Center | 4822 Cleveland Ave S, Canton, OH 44707-1034 | 2016-11-11 |
| 1861818460 | Majid M Taj Md Pllc | Clinic/Center | 41750 Michigan Ave, Canton, MI 48188-2679 | 2014-03-07 |
| 1386081529 | Canton Family Medicine and Medical Spa, Pllc | Clinic/Center | 5958 N Canton Center Rd, Suite 200, Canton, MI 48187-2765 | 2013-05-29 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.